Elder Law Planning: What Seniors Should Know About MassHealth
Long-term care planning is an important part of estate planning. Medicare provides only very limited coverage for long-term care needs. Medicaid or MassHealth is the public program that provides long-term care support. Here, our Norwood elder law attorney explains the most important things that seniors in Massachusetts should know about the MassHealth program.
What is MassHealth?
While MassHealth provides comprehensive health coverage for eligible low- and moderate-income residents, including children, pregnant women, parents, seniors, and people with disabilities for a wide range of services, such as doctor visits, hospital stays, and prescription drugs, MassHealth also provides coverage for health care for seniors in certain settings, such as some assisted living facilities under the PACE program, in-home skilled care, and skilled care in a nursing facility. This article will focus on MassHealth eligibility for skilled care in a nursing home.
MassHealth and Long-Term Care in Massachusetts
MassHealth is the public program that covers long-term care services in Massachusetts—not Medicare. While Medicare may pay for short-term rehabilitation or skilled nursing care following a hospital stay, it does not cover custodial care or extended stays in nursing homes.
On the other hand, MassHealth offers comprehensive long-term care benefits for eligible seniors who require assistance with daily activities such as bathing, eating, or dressing. Along with other things, services include nursing home care and certain in-home services.
Medicaid Through MassHealth is Not an Entitlement
Seniors can qualify for Medicare based on their age alone. However, that is not the case with Medicaid through MassHealth. There are strict medical and financial eligibility requirements for Medicaid coverage for long-term care for seniors. Here is an overview of what is needed to qualify for skilled care in a nursing home:
- Seniors Must Be a Massachusetts Resident: MassHealth only offers comprehensive coverage, including long-term care services to Massachusetts residents who are U.S. citizens or who have an eligible immigration status.
- Seniors Must Have Medical Need: To qualify for services, an applicant must require assistance with three out of five activities of daily living (ADLs) or meet a nursing facility level of care.
- Applicants Must Meet the Asset Limit: The asset limit is $2,000 of countable assets for the applicant. If the applicant is married, then, , the non-applicant spouse or community spouse may retain countable assets up to $157,920 (2025) Bank accounts, investment or brokerage accounts, IRA/401(K)/403(B) accounts, second homes, second vehicles, life insurance policies, and annuities are all countable assets. Exempt or non-countable assets are your primary residence, provided the equity does not exceed $1,097,000, and one vehicle. Income: While there are income limitations on certain MassHealth programs, income is generally not a part of the financial eligibility test for skilled care in a nursing home. However, once eligible for MassHealth, the applicant must contribute a significant portion of his or her monthly income to care. After adding all of an applicant’s gross monthly social security and pension(s), the applicant can deduct Part B of the Medicare portion of his or her gross Social Security payment and can keep the monthly cost of his or her Medigap insurance and keep $72.80 as a Personal Needs Allowance for haircuts, replenishment of the sock drawer or other personal services. If the nursing home resident is married to a spouse who lives at home or in assisted living, income from the nursing home spouse may be kept by the healthy spouse under a certain formula, with the amount kept by the community spouse called the Minimum Monthly Maintenance Needs Allowance or MMMNA. MassHealth will pay the difference between what is paid by the applicant to the nursing facility and its monthly rate of approximately $13,230. It is important to note that MassHealth does not pay a facility the private pay rate of approximately $550 per day or $16,500 per month. That cost is paid by residents that cannot qualify or opt not to apply for benefits.
- Despite these limitations, there are pre-planning strategies and crisis strategies that are available to achieve eligibility.
- Contact Our Norwood, MA Elder Lawyer Today
At Fisher Law LLC, our Massachusetts elder law attorneys have been assisting individuals and families in the Greater Boston area with MassHealth eligibility and applications since 2008. We have the knowledge and experience to assist families with planning for potential, future care needs and where care is needed in the near term and where little to no planning has been done. Pre-planning is always recommended. . If you have any questions about MassHealth or long-term care planning and would like to discuss what we can achieve for you, please give us a call or contact us online for a fully confidential consultation. With an office in Norwood, we provide elder law services in Norfolk County and throughout the Greater Boston area.
Source:
mass.gov/topics/masshealth
